Health Care System 
By Walter Sorochan, HSD, MPH, MSc, BPE; Emeritus Professor, San Diego State University

Posted update July 27, 2012,  Disclaimer

For a more recent update on Obamacare --- the good and the bad, go to:  New health care system for USA

This article was an earlier response to an opinion comparing United States and Canadian health care systems.  This is a response to the an article by Ed Bugod, that appeared as “Thoughts from a Canadian on the Canadian Socialized Medical System,” Whiskey and Gunpowder, April 18, 2011. Article Canadian-USA health care system  For more details on this comparison of two health care systems, go to: RE: Debate Canadian vs USA Health Care Systems  While critiquing the flaws of Bugod's article, this is an excellent article about what a future health care system should be. 

The author, Walter Sorochan, responded with the following observations.  Re: USA vs Canada Health Care Systems.

You are opening a can of worms when you open dialogue about the USA and Canadian health care systems. Or should I say, health care systems in general.  

During my tenure professor of Public Health and Health Science from San Diego State University. , I was fortunate to have taken classes from several renown experts [ UCLA ] on health care systems of the world. During my tenure I also developed a course on International Health and then taught it for numerous years. While developing the course, I used a statistical data-base to validate health parameters in order to be able to distinguish a good health care system from a not so good one. I stayed away from personal bias and testimonials in deciding on best versus not so good systems [ as seems to be the case with the comments of your guests. ]  

I share this background with you, not to impress you with my possible credentials, but to make you aware that one does need some expertise in unraveling the can of worms about healthcare systems that interested readers may have. Also to alert you that on the one hand, health is a topic that everyone feels qualified to talk about for they are living it; and on the other hand, being alive does not necessarily qualify one to become an expert on health, much less health care systems. How one feels about a health care system is not a scientific or rational way to evaluate a system. One needs data and to be informed in order to back up or justify the comment that one system is good or bad.  

With these introductory remarks, I would like to point out a few guiding principles about the best health care systems:  

    1. there is no single best health care system in the world
    2. need to look at the total population of a country and not at a few disgruntled individuals
    3. each health care system is unique to its culture
    4. health care system is based on spending and is often covered under the umbrella of social welfare, retirement, old age pensions, as well as research, public health, health care and so on
    5. health care systems in each country are going to be in a constant state of flux and change; best systems adapt to the cultural values, the economy of the times, and so on
    6. health care systems are based on expertise that is not politically or economically determined
    7. health care systems do not allow anyone to make profit on sick or disabled or indigent people
    8. Portability or allow coverage to follow person from job to job & location to location
    9. the most economic systems are those that have a single payor provider for the health care and options for additional minor ones
    10. the argument that a health care system may be socialized medicine or free enterprise is childish and uninformed.
    11. Most health care systems are based on the pocket book
    12. health care systems are evolved with social justice in mind:
  • the group is more important than the individual [ this is not socialized medicine ]
  • universal coverage for all [ everyone is covered ]
  • Comprehensive coverage [for all disorders, diseases, dental, mental illnesses, etc.. ]
  • Variety of treatment options [ emergency rooms, hospice, elderly care, baby sitting care, retirement homes, public health, occupational health, emergency room, ]
  • economic incentives for everyone so as to keep costs down
  • No one makes a profit on sick people
  • Health care is a right of everyone
  • Priorities of who gets health care first [ e.g. children and pregnant women or health middle agers ]
  • Choice: everyone has same choice of doctors and care
  • Economic incentives for doctors to provide better health care [ bonus for fewer smokers, less obesity, exercising, lower blood pressure, etc. ]

Now you and others can disagree on these principles. Doing so is like shopping for an automobile while choking on emitted auto pollution and then buying and driving a polluting car. This shows disrespect for expertise knowledge [ such as Gerard Anderson, professor at John Hopkins School of Medicine and a leading expert on international comparisons; and the Lewin Group, prestigious analysts of medical socio-economics, who have shown that changing to the Canadian health care system would save appreciable money ], disrespect for wellbeing of others, balancing the budget, respect for others having quality of life and so on.  

RE: Controversy about Canadian health care system.  

It is obvious from the few comments made in your newsletter that these are unsubstantiated observations and possible complaints, but these comments are incorrect. Furthermore, one or two cases do not make an average of how the system works. You need to look at the forest and not a few trees.  

Canada’s health care system is not socialized medicine. Some 95 percent of Canada’s hospitals are privately owned and pay the salary of the personnel. The doctors work on a fee-for-service basis just as their counterparts in the United States. [ Alex Gerber, emeritus professor at University of Southern California and former health care consultant to the White Housed and US Department of health and Human Services ].  

You and your responders need to get your facts straight and compare apples to apples and not peanuts to donkeys. For example, use statistical data, like infant mortality rates, longevity, cost of health care per person, number persons covered, number of doctors and registered nurses per capita, life expectancy, and so on as a basis for evaluating a health care system. Another related aspect of health is the number of poor people who cannot get adequate health care because they have no money to pay for it. If you peal off the health care system layer by layer, you find that health is affected by many factors that insurance companies and politicians do not want to talk about and most citizens are not aware of.  

Although the Canadian health care system is not unique nor the best, it is a good one. Many Scandinavian countries, including Japan, Australia, United Kingdom, Germany and France, have equally good but not perfect systems. These countries cover the cost of health care in ways that are very different from the Canadian or current USA system.  

RE: Michael Moore’s video “ Sicko” is a documentary and was intended to focus attention on our inadequate health care system. It stirs thinking among the population. It was not intended to be a bible on health care systems.  

The Real Fix: 

The major obstacle to our health care system is our political-economic approach to solving it. We have a corrupt political system that allows drug companies and insurance corporations to lobby and thereby control health care and the government in this country. We need to stop allowing others from making a profit on health care. We need to fix the political problem before we can fix the health care system.

The Chinese culture 2000 years ago had the following health care system: A doctor was paid for keeping people healthy. If a person under his care got sick, then the doctor had to treat that person without pay.  

The second major fix is to rebuild the health care system. The current system has had a very weak foundation upon which it was built in 1903 [ when the Flexner report revolutionized the training of medical doctors in the United States ]. We have been band-aiding the fixing of the health care system ever since. Consequently, the fixes are like rooms being added to a house that has no foundation, resulting in the rooms continuously collapsing.

The real solution or fix is to build the health care house by starting with a solid foundation. We need to build from the bottom up and not as we have been doing for the past 100 years --- adding rooms helter-skelter without a master plan.  Obama's 2012 approach to fixing the US health care system is a very poor band aid that will not fix the problems in the long run. Attempted sporadic reforms will be difficult. 

Finally, acceptance and impetus for real change will probably come when the pockets of citizens and this country are empty. This will force politicians to speedily adopt a good and realistic health care system.